Healthcare Provider Details

I. General information

NPI: 1124569868
Provider Name (Legal Business Name): PARADISE PATIENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

3655 W ANTHEM WAY SUITE A109 PMB 313
ANTHEM AZ
85086-0430
US

V. Phone/Fax

Practice location:
  • Phone: 623-505-9880
  • Fax:
Mailing address:
  • Phone: 623-505-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LILIANA PEREZ
Title or Position: ADMIN
Credential:
Phone: 623-505-9880